Mentee Intake Form Contact Details Full Name First Name Last Name Preferred name Gender MaleFemale Business Name Address Street Address Street Address Line 2 Street Address Line 2 City City State/ Province Postal/ Zip Code Postal/ Zip Code Country Please select... 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High School GED Bachelor's Degree Master's Degree Doctorate How many years of work experience do you have? Please select... 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 Have you owned your own business? YesNo If yes, for how many years? Please select... 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 What was the name of the business you owned/managed? What is the business' website? Profile Briefly describe your business: What stage is your business in: Please select... Start-up Existing Business Approximately when was your business started? Do you have a business plan? YesNo Please Upload your Business Plan: In Which industry do you operate in? Please select... Art/ Judaica Artwork Building Car Leasing Catering Cleaning Clothing Kids Clothing Women Commodities Consulting Contract Law Data Security Diamond E Commerce Event Management Finance Food Framing Furniture Graphic Artist Gutters Healthcare Healthcare Insurance High Level Computers Hospitality Insurance Sales Jewelry Large Manufacturing Makeup Marketing Odd Lot Sales Patent Law Photography Printing Process Manufacturing Property Management Publishing Real Estate Retail Roofing Sales Siding Spread Sheet Supplies Tech Toys Vitamins Wholesale Select area you feel you need help in? Please select... 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